Provider Demographics
NPI:1144190752
Name:ARRINGTON, KEONTAE
Entity type:Individual
Prefix:
First Name:KEONTAE
Middle Name:
Last Name:ARRINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 185TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-5224
Mailing Address - Country:US
Mailing Address - Phone:708-762-2907
Mailing Address - Fax:
Practice Address - Street 1:4650 185TH ST
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB HILLS
Practice Address - State:IL
Practice Address - Zip Code:60478-5224
Practice Address - Country:US
Practice Address - Phone:708-762-2907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-08
Last Update Date:2025-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician